Specialist Clinics and the Trans Community

12/07/2016 16:40 | Updated 12 July 2016

I am a gender specialist and NHS GP. I set up earlier this year to provide free advice to trans adults and parents of children suffering with gender identity disorder, seeking medical support. The service, which also offers private care to those who want it, was set up after I came to the realisation that the situation for many patients suffering with gender identity disorder in the UK, was dire.

The combination of excessive (and arguably illegal) waiting times, prejudice from health care workers and a lack of sufficient evidence to inform treatment pathways, has led to a situation where patients often feel that they have nowhere to turn. For those that do seek help, the waiting time for initial referral can be more than a year, and sometimes as long as four years, which only goes to exacerbate their feelings of desperation.

Self-harm and suicide rates are startlingly high among this group. Distress, anxiety and depression are far too common.

Through my clinic I offer diagnosis, assessments and safe, reliable medication and monitoring. Many people use my service as a stopgap, ensuring that, if they meet the criteria, they can start the process of hormonal treatment while they begin the long wait for NHS referral.

GenderGP follows the good practice guidelines for the assessment and treatment of adults
with gender dysphoria as set out by The World Professional Association for Transgender Health (WPATH). Guidelines include the following recommendations set out by the Royal College of Psychiatrists which clearly state that medical opinions are required 'at the crucial stages of commencing hormone therapies' and highlights the fact that patients must demonstrate:

- persistent and well-documented gender dysphoria
- capacity to make fully informed decisions and to consent to treatment
- if significant medical or mental health concerns are present, they must be
reasonably well controlled

In my clinic, each patient is treated individually and their care plan is tailored to their needs and adjusted according to their response to the medication prescribed. My primary focus is on treating adult patients.

However, parents of children suffering with gender identity disorder do use the service and I have treated children, usually those in their later teens. These children are absolutely desperate to halt the terrifying and unmerciful pubertal changes that are going to stay with them forever, if the wrong puberty is allowed to progress.

For children in whom the diagnosis is clear, and where there has been a persistent and unwavering identification as the opposite gender, treatment options should be discussed and given, as appropriate.

Many children from the UK have been travelling to Boston in the US, or to Hamburg in Germany, to access private care that they are unable to access on the NHS, due to the strict protocols in place, which are not necessarily evidence-based.

Early intervention is not appropriate for all children, but each case should be taken on its merits, and a secure management plan negotiated and agreed with all those involved.

For pre pubescent patients, once puberty has been halted through the use of blocking medication, they feel they have time to think and make the decision that is right for them, without any additional pressure. If they decide that it is the correct path for them, they would subsequently move on to cross-sex hormones to allow them to achieve, what for them, is the right puberty.

The twelve-year old referenced in the media over recent days is an unusual case, and the youngest patient I have treated. Since starting treatment they have grown in confidence and their distress, anxiety and low self-esteem have vanished. In this case, it was the right thing to do. It may not be right for everyone, but for those who feel that medication is the only option other than suicide or self-harm, they should be allowed to be involved - and influence - the decision-making process. Too many children who question the current NHS rules are told that they cannot access the medication 'because it is against protocol'.

We should not be dictating treatment based on age limits alone. We should be patient-centred and flexible, judging each situation on its own merits. Yes, it is unusual to treat younger children with hormones, but in some cases, after full discussion of the risks, benefits and side effects, and with family and psychological support, it is the right thing to do to ensure that patient's long-term wellbeing.

The response I have had to the service has been overwhelming, and it is abundantly clear that there is a real need for compassionate medical care for the transgender community.